[NAIROBI] Grief over the loss of a child poses a threat to public health in Sub-Saharan Africa, as nearly two-thirds of mothers in some countries suffer the death of at least one child, a study has found.

According to the study published this month in the Proceedings of the National Academy of Sciences, more than half of women aged 45 to 49 years in some Sub-Saharan African countries have experienced the death of a child under the age of five.

“In the shadows of very high child mortality rates that the global health community typically focuses on are all these grieving parents that never receive any attention.”

Emily Smith-Greenaway, University of Southern California

“In Benin, Burkina Faso, Liberia, Malawi, Mali, and Niger, having had at least one infant die was a more common experience than having had all of one’s children survive infancy,” the study explains.

“In no country has the [total infant deaths] fallen below 100 per 1000 for mothers age 45 to 49, and only in Benin, Kenya, Namibia and Zimbabwe has it fallen below 200 per 1000.”

Researchers analysed the prevalence of infant and child deaths for every 1000 mothers using demographic and health surveys over a 30-year period, from 20 countries.

“In the shadows of very high child mortality rates that the global health community typically focuses on are all these grieving parents that never receive any attention,” says lead author Emily Smith-Greenaway, an assistant professor of sociology at the US-based University of Southern California.

“These results increase our recognition of bereavement as itself a public health threat — one that’s unfairly concentrated in low-income regions of the world.”

A recent study of child deaths in Iceland over 200 years notes that mothers who lose a child have elevated risks of psychiatric symptoms and psychiatric hospitalisations, cardiovascular disease, and some cancers. The study found that “child loss is likely to constitute a major threat to the survival of mothers in societies with high infant mortality rates”.

The study, in eLife Sciences Publications, found there was a “large increase in the rate of premature maternal mortality after child loss”, but only a limited increase in paternal deaths, suggesting differences in attachment, and emotional responses to trauma, as possible factors.

This is known by some as the ‘maternal bereavement effect’.

A seemingly universal maternal reaction to the loss of a child is a feeling of guilt. The World Health Organization reports that cultural and societal attitudes to baby or child deaths vary globally, but in Sub-Saharan Africa it is a common belief that a baby may be stillborn because of witchcraft or evil spirits.

Female genital mutilation and child marriage cause immense damage to girls’ sexual and reproductive health, and the health of their babies, the WHO says. The way women are treated during pregnancy is linked to sexual and reproductive rights, which are lacking in many parts of the world.

Smith-Greenaway tells SciDev.Net that although parental bereavement research has been receiving increasing attention in North America and Western Europe, it is overlooked in Sub-Saharan Africa.

Phelgona A. Otieno, a paediatrician and epidemiologist at the Kenya Medical Research Institute's Centre for Clinical Research, praises the researchers for conducting a study that “takes an interesting turn and calls for countries to recognise the impact of child mortality on women and bereavement as a public health threat”.

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“Poor access to quality, affordable health care is one of the biggest factors especially in low-income countries. Poor nutrition is also a factor since children who suffer from malnutrition are more vulnerable to disease,” she says.

The burden of loss is especially heavy for mothers not only because of the pregnancy and childbirth experience, but because they are also the primary care givers to their children, she adds.

Smith-Greenaway says it is important to create programmes in Sub-Saharan Africa that support bereaved mothers as they navigate life after loss.